1629105085 NPI number — RICHARD C ZIMM PA-C

Table of content: RICHARD C ZIMM PA-C (NPI 1629105085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629105085 NPI number — RICHARD C ZIMM PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMM
Provider First Name:
RICHARD
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629105085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STATE ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-456-6022
Provider Business Mailing Address Fax Number:
814-455-4731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-456-6022
Provider Business Practice Location Address Fax Number:
814-455-4731
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  MA052248 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8Y8753 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com